Trans-catheter aortic valve implantation without contrast using the Lotus mechanically-expanded heart valve

We report a case of a TAVI in an 80-year-old patient with severe AS and significant chronic kidney disease (CKD), which was carried out without the use of contrast and with minimal procedural hypotension.Pre-procedural imaging was carried out using 3D trans-esophageal echocardiography (TEE) rather than computed tomography (CT) to avoid contrast administration. The Lotus valve (Boston Scientific, Marlborough, MA, USA) was chosen due to a number of design features which minimize both the need for contrast injection and procedural hypotension during valve positioning and deployment. The procedure was carried out successfully and produced an excellent result with no decline in renal function. We believe that the approach of using TEE and the mechanically-expanded Lotus valve illustrates an important therapeutic approach in patients with severe CKD.
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research

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CONCLUSIONS: In patients with T2DM and CKD, SGLT2 inhibitors have a decreased glucose-lowering effect compared to patients without CKD. Renal benefits among patients with CKD are similar to those without CKD and include a significant reduction in albuminuria and reduced incidence of worsening albuminuria. Given that CKD and T2DM are both associated with increased cardiovascular risk, we believe these agents should considered as preferred add-on agents in most patients with uncontrolled T2DM and eGFR>30 ml/min/1.73m2. Ongoing studies will provide additional information as to whether these agents should be added to the cu...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
Posttraumatic elbow stiffness is common with the primary indication for contracture release being limited motion that affects functional activities which has not adequately improved after intensive therapy and rehabilitation. Preoperative evaluation focuses on the history of previous nonoperative and/or operative treatment, physical exam with particular attention paid to the status of the ulnar nerve, and imaging consisting of radiographs and computed tomography. There are multiple intrinsic and extrinsic causes of posttraumatic contracture. In general, limitation of motion in one direction can be attributed to a mechanica...
Source: Techniques in Hand and Upper Extremity Surgery - Category: Surgery Tags: Technique Source Type: research
EMPHYSEMA QUANTIFICATION ON SIMULATED X-RAYS THROUGH DEEP LEARNING TECHNIQUES. Proc IEEE Int Symp Biomed Imaging. 2018 Apr;2018:273-276 Authors: Campo MI, Pascau J, José Estépar RS Abstract Emphysema quantification techniques rely on the use of CT scans, but they are rarely used in the diagnosis and management of patients with COPD; X-ray films are the preferred method to do this. However, this diagnosis method is very controversial, as there are not established guidelines to define the disease, sensitivity is low, and quantification cannot be done. We developed a quantification method ba...
Source: Proceedings - International Symposium on Biomedical Imaging - Category: Radiology Tags: Proc IEEE Int Symp Biomed Imaging Source Type: research
Authors: Zhao M, Wang L, Chen J, Nie D, Cong Y, Ahmad S, Ho A, Yuan P, Fung SH, Deng HH, Xia J, Shen D Abstract Automatic segmentation of medical images finds abundant applications in clinical studies. Computed Tomography (CT) imaging plays a critical role in diagnostic and surgical planning of craniomaxillofacial (CMF) surgeries as it shows clear bony structures. However, CT imaging poses radiation risks for the subjects being scanned. Alternatively, Magnetic Resonance Imaging (MRI) is considered to be safe and provides good visualization of the soft tissues, but the bony structures appear invisible from MRI. Ther...
Source: MICCAI International Conference on Medical Image Computing and Computer-Assisted Intervention - Category: Radiology Tags: Med Image Comput Comput Assist Interv Source Type: research
This article outlines the basic science behind the mechanical and inflammatory model of development of PTOA of the ankle. The purpose of this article is to review the state of literature and understanding of ankle PTOA and serve as a foundation for future research aimed at reducing severity and progression of PTOA. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Source: Techniques in Foot and Ankle Surgery - Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research
Conclusions: Acetabular fractures with posterior wall involvement are associated with a significantly higher rate of conversion to THA if reduction is not near-anatomic. A combination of clinical/radiographic findings is associated with poorer reductions and higher rate of conversion to THA. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Source: Journal of Orthopaedic Trauma - Category: Orthopaedics Tags: Original Article Source Type: research
Objectives: To evaluate the accuracy of reduction of the acetabular articular surface using an intraoperative computed tomography scanner (O-Arm) and screw navigation compared with a classical open technique. Design: Prospective matched cohort study. Setting: Tertiary referral center. Patients/Participants: Adult patients with acute acetabular fractures were included in the study. All patients were treated by 2 senior surgeons using intraoperative imaging and screw navigation. Main Outcome Measurements: The primary outcome measure was articular reduction. Secondary outcomes were radiation dosage, operative va...
Source: Journal of Orthopaedic Trauma - Category: Orthopaedics Tags: Original Article Source Type: research
Conclusions: The inherent anteversion of a second generation nail can be used to minimize malrotation of the femur after comminuted fractures during locked intramedullary nailing in patients with normal anteversion and is superior to our present fluoroscopic technique. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Source: Journal of Orthopaedic Trauma - Category: Orthopaedics Tags: Original Article Source Type: research
Conclusion: Long-term patient satisfaction is significantly associated with the subjective symptom severity prior to treatment, i.e., postnasal drip and overall disease severity (SNOT-22 score), but not with the objective severity of the disease (CT score and inflammation).ORL 2019;81:1 –9
Source: ORL - Category: ENT & OMF Source Type: research
We present a computed tomography image of a patient with acute necrotizing pancreatitis due to alcohol, who developed several pseudocysts, one of which fistulized into the colon. PMID: 30449120 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
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